Provider Demographics
NPI:1659437515
Name:MATERI, CATHERINE RENEE (MA LSPE)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RENEE
Last Name:MATERI
Suffix:
Gender:F
Credentials:MA LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SE ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4419
Mailing Address - Country:US
Mailing Address - Phone:931-455-1551
Mailing Address - Fax:931-455-0551
Practice Address - Street 1:211 SE ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4419
Practice Address - Country:US
Practice Address - Phone:931-455-1551
Practice Address - Fax:931-455-0551
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN202775OtherCIGNA
TN3024114OtherBCBS
TNIP272392OtherGREENSPRINGS